On a recent vacation
to a theme park, the thing that stood out to me the most was the significant number of adults riding in rented mobility scooters and wheelchairs with no evident physical handicap other than being overweight. [Note: I acknowledge that not all legitimate disabilities are visible. Note further that individuals with long-term disabilities would be more likely to have their own assistive devices, not using rented devices.] While observing this functional decline, we averaged at least ~15,000 steps per day, which is considerably more than we would walk on a typical day.
Walking around the park, I couldn’t help thinking about what it takes to avoid the fate of being dependent on a powered scooter and instead to be among the vibrant, physically active individuals who are able to log several thousand steps daily.
Daily step goals
The ingrained notion of walking 10,000 steps per day originated from a Japanese marketing campaign for a pedometer called “Manpo-Kei” – literally “10,000 steps meter”. The arbitrary goal of 10,000 steps per day is not based on any scientific evidence, but it provides a reasonable target for physical activity.
As of 2017, the average American walked only 4,774 steps daily. It probably hasn’t improved any over the last few years, as there has been a significant shift towards working from home, likely resulting in a lower average step count. Few would argue that increasing physical activity among American adults would be beneficial.
Disturbing trends
There is a disturbing trend 
towards decreasing mobility and functional status of aging adults, with more than 35% of individuals over the age of 70 suffering limitations to their mobility. With limited mobility, simple activities of daily living may become burdensome chores requiring significant effort.
During my time working in the hospital, I routinely encountered individuals who were deconditioned to the point that they would have to call Emergency Medical Services (e.g. 911) in the event that they slid/fell to the floor, as they did not have the strength to get up, often multiple times per month. Similarly, many other hospitalized patients have been deemed unsafe to return home and are awaiting placement to rehabilitation facilities. If only they had known years ago that they would eventually be imprisoned by their immobility, what would they have done differently?
Use it or lose it
Mobility, just like strength, must be maintained on a regular basis. 
It’s not a one-time investment. Over time, our aging bodies suffer impairment in multiple areas: muscles, joints, central nervous system, peripheral nervous system, energy efficiency, etc. We must actively work against the aging process day after day, year after year.
Downward spiral of immobility
A decrease in activity leads to reduced strength, reduced mobility, and a loss of muscle mass (sarcopenia). As these problems worsen, there is a significantly increased risk of falls and injuries, which then may cause further decreases in mobility and activity. This vicious cycle of immobility has significant implications for well-being and physical health.
Costs of immobility
It’s no fun to lose the ability to move one’s body, and it shows in those who have. Loss of mobility means loss of independence, which can weigh heavily on one’s mental health. Declining physical activity also contributes to declining quality of life, with less interaction with one’s world. It’s also important to know that the stakes are high — decreased muscle strength and the associated falls/injuries that inevitably follow are associated with increased mortality.
Am I doomed?
If you expect to age gracefully and maintain your current level of activity without any effort on your part, you will eventually have a rude awakening. It is imperative that you be proactive in maintaining regular physical activity in order to preserve your current level of functioning. Otherwise, the evil hands of time will take it all from you. At the risk of sounding cliché, it’s all about prevention.
The solution is rather simple:
- Just keep moving. Be consistent.
- Vary your activity. Move your body in different ways.
